Free Health Records Request Letter Template
Health Records Request Letter
November 27, 2090
To: Ms. Sarah Lim
Medical Records Department
Springfield General Hospital
456 Health Way
Springfield, IL 62701
Dear Ms. Lim,
I am writing to formally request a copy of my health records under the Health Insurance Portability and Accountability Act (HIPAA). I would like to receive the following documents:
-
Complete medical history and treatment records
-
Lab results and imaging reports from January 1, 2090, to December 31, 2090
-
Consultation notes and discharge summaries from all visits during that period
For verification purposes, my details are as follows:
-
Full Name: John Doe
-
Date of Birth: March 15, 2050
-
Medical Record Number: 123456789
Please send the requested records to the address listed above. Alternatively, if electronic delivery is available, you may email them to my email address at [Your Email].
If there are any fees associated with processing this request, kindly inform me beforehand. I would appreciate it if you could confirm receipt of this letter and provide an estimated timeline for when I can expect to receive the requested documents.
Thank you for your attention to this matter. I look forward to your prompt response.
Sincerely,
[Your Name]
